Provider Demographics
NPI:1396753315
Name:BERTHELSEN, BOBETTA JEANNE (MD)
Entity type:Individual
Prefix:
First Name:BOBETTA
Middle Name:JEANNE
Last Name:BERTHELSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37333 STATE HIGHWAY 299 E
Mailing Address - Street 2:
Mailing Address - City:BURNEY
Mailing Address - State:CA
Mailing Address - Zip Code:96013
Mailing Address - Country:US
Mailing Address - Phone:530-335-2233
Mailing Address - Fax:530-335-3933
Practice Address - Street 1:37333 STATE HIGHWAY 299 E
Practice Address - Street 2:
Practice Address - City:BURNEY
Practice Address - State:CA
Practice Address - Zip Code:96013
Practice Address - Country:US
Practice Address - Phone:530-335-2233
Practice Address - Fax:530-335-3933
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG23953207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G239530Medicaid
CA00G239530Medicaid
E59266Medicare UPIN